Category Archives: Uncategorized

April 9, 2013 · 10:22 PM

Invalidation at the Multiplex

... and invalidation won't actually toughen up your kid.

… and invalidation won’t actually toughen up your kid.

This week, I spotted ads for the upcoming After Earth at the local movie theater. Between the tensed faces of Will and Jaden Smith, the poster blurbs, “Danger is Real. Fear is a Choice.“

Oh, Hollywood. So much sex. So much violence. So little psychological accuracy. Any $275-per-hour L.A. psychologist could have told you: emotions aren’t a rational choice, any more than logic is an emotional impulse. To tell people otherwise is invalidating.

Invalidation happens any time clients get the message their emotions or beliefs are flawed, wrong or unimportant. It is more than just negativity: “You failed the test,” states a fact. “Don’t tell me you studied when you bring home an F,” invalidates all of the student’s effort.

Everyone can handle a little. What kid has never heard, “You can’t be hungry, you just ate”? Repeated invalidation leaves people in doubt about their emotions and themselves. It’s associated with poor social skills in children,  self-harm in teen-agers, psychological distress in adulthood and worsened rheumatoid arthritis in sufferers of all ages.  In cognitive-behavioral therapy, it takes a delicate touch to challenge clients’ beliefs without invalidating them as people. When people hear enough repetitions of, “You put the pressure on yourself,” “Let’s hold a pity party,” or “Stop being so dramatic,” they’ll start invalidating themselves.

New, hesitant clients often say, “Maybe I should just get over it.”  They’ve absorbed the idea they can fix their emotional issues by choosing not to have them. The trouble is, emotions are like pets and children. We’re each responsible for our own, but we control them indirectly at best.  If you start by believing anxiety means you are weak and self-indulgent, you can wind up certain you are a failure when it doesn’t go away.

C’mon, Tinseltown! How about a tag line like,

“Danger is real.

Fear is a normal, healthy emotion everyone experiences.

You can manage it effectively with  mindful acceptance and self-validation.”

That would be much more accurate, and only cut ticket sales by half.

n.b.: . Steve Hein, of EQI.org has a .pdf on invalidation for parents of teen-agers here. Worth a read.

@ 2013 Jonathan Miller All Rights Reserved

Leave a Comment

Filed under Uncategorized

Tagged as , , ,

March 25, 2013 · 8:07 PM

Hearts, Darkness and Chinua Achebe

The Nigerian novelist, Chinua Achebe,  died last week. Besides being, “one of the greatest writers of the 20th century,”  he was also a publisher, professor, deputy vice-president of a Nigerian political party and a stalwart champion for third-world writers. I studied under Achebe in undergrad.  In one class, he taught something invaluable for therapy practice.

Chinua_Achebe_- resized

RIP Chinua Achebe: November 16, 1930 – March 21, 2013

This day, we asked Professor Achebe about his famous critique of Joseph Conrad’s Heart of Darkness. First, we took deep breaths. The professor always spoke with quiet, measured dignity; so much so, it took courage once to tell him he was teaching next week’s book. Pulses calmed, we asked: was it fair to call Conrad’s masterwork racist? Didn’t  Kurtz’s character show it was Europeans who disgusted the author?

Gently, he explained we had missed his point entirely.

heartofdarknessAchebe told us about childhood in a Nigeria that was part of the British empire; where his schoolbooks taught the story of, “we Britons,” and the few Africans in storybooks were savages.  To him, it wasn’t the spears or loincloths that made these fictional natives sub-human.  He himself wrote a book in which tribesmen kill and eat a man, chatting casually over their meal. His point was speech. The only natives who speak aloud in Heart of Darkness, he said, are those under the ‘civilizing influence’ Conrad viewed with irony and despair.  The professor, a master of many languages, opined Conrad dehumanizes his natives because he limits them to animalistic shrieks and war whoops. At least Achebe let his cannibals talk.

In our first counseling class, we’re taught we should speak 30% of the time and listen 70%.  In session, we fight the urge to interrupt our clients and tell them how to fix their problems. A psychology professor told me in his years as a therapist, the lesson he’d re-learned the most was, “Shut up and listen.” Professor Achebe would have appreciated his effort. Clients often come to us because no one else will hear. Letting people talk can give back their humanity.

@ 2013 Jonathan Miller All Rights Reserved

1 Comment

Filed under Uncategorized

Tagged as , , , , , ,

January 7, 2013 · 8:29 PM

“Six Harsh Truths” and depression

David Wong‘s Six Harsh Truths That Will Make You a Better Person is a New Year’s essay for those who lack resolution – one that applies directly to treating depression.

If you want to know why society seems to shun you, or why you seem to get no respect, it’s because society is full of people who need things … the moment you came into the world, you became part of a system designed purely to see to people’s needs.

 Either you will go about the task of seeing to those needs by learning a unique set of skills, or the world will reject you, no matter how kind, giving and polite you are. You will be poor, you will be alone, you will be left out in the cold.

 Does that seem mean, or crass, or materialistic? What about love and kindness — don’t those things matter? Of course. As long as they result in you doing things for people that they can’t get elsewhere.

He’s talking to those paralyzed by the dissatisfaction they feel with their lives, and that includes those with Major Depressive Disorder. As  Marsha Linehan pointed out, the best medicine for unpleasant emotions is often the opposite of what the emotion makes us want to do.  “Opposite action” is Wong’s prescription for those who are disgruntled but inert: do something. Anything. Anything  more than what you do now, that would also be useful to others. He stands with  Roy F. Baumeister, whose research shows we don’t achieve because we have good self-esteem. Per the Florida State University researcher, if there’s a relationship between the two variables,  it’s much more likely we have good self-esteem because we achieve.

It’s a shame Wong builds his argument on Alec Baldwin’s role in Glengarry Glen Ross as a manager who shames and threatens his sales force.  Who gets motivated from abuse? Those galvanized by anxiety – the sort of highly-motivated go-getters who rarely need our help. Wong doesn’t scorn his readers for freezing in fear of rejection and failure. His point is simpler: the world values you for what you do. You can be valued more highly by doing more.

In cognitive-behavioral therapy, the most effective reframes for thoughts of, “I’m worthless,” are usually about accomplishments – grades the client earned, projects they completed, people they have helped. Once I’ve helped a client identify all of the reasons they aren’t garbage, I’m going to ask, “Now that we’ve settled that, what do you want to do that would make you even more worthwhile?”

@ 2013 Jonathan Miller All Rights Reserved

2 Comments

Filed under depression, Uncategorized

Tagged as , , , , , ,

November 25, 2012 · 2:37 PM

Successful Branding: Don’t Be a Therapist

Interesting New York Times article here about a rookie therapist who sought branding experts’ help in building her private practice. It seems the key to success is to choose a hyper-specific niche, tweet banalities, study pop culture, make borderline-inappropriate self-disclosures,  be available 24/7, treat clients via text message, reassure them they don’t need to make changes and downplay the fact you’re a therapist.

On that note, I’m going back to bed.

@ 2012 Jonathan Miller All Rights Reserved

3 Comments

Filed under Uncategorized

Tagged as , ,

November 22, 2012 · 1:44 PM

On Resentment

Photo copyright 2012 by Jenny Rollo“Resentment is the most precious flower of poverty” – Carson McCullers

On the third Thursday of each November, we Americans bow our heads and meditate on all we are thankful for. For those of us who like our turkey tartened with cranberry sauce, here are a few thoughts on gratitude’s opposite.

What is Resentment?

The word begins with the prefix re (as in repeat) and adds from the Latin sentire – to feel. Ordinary anger flares up and is quenched. Resentment is felt over and over. Vengefulness takes action. Hostility and rage lash out.  Resentment is passive and slow-fermenting. One can be bitter at life in general, but we are resentful towards people. We feel prejudice because of who others are, but we are resentful over what others have done.  Or not done. No one begrudges basement inventors their new-found wealth, but blue-collar teens are often resentful towards rich kids who did nothing to deserve designer clothes or private-school education.

Philosopher Robert C. Solomon pointed out resentment involves inferiority; we resent our siblings for taking up more of our parents’ time and attention. Like all anger, resentment involves the perception of victimization. If our younger brother gets more maternal love, we get less. Resentment is often misplaced; Li’l Brother didn’t ask to be Mom’s favorite, after all.

Photo copyright 2012 by Kavitha ShivanThere’s even a special type of resentment when it affects our perceptions of the world: ressentiment. Per thinkers such as Kierkegaard and Nietzsche, ressentiment means you’ve invented a morality-based explanation of your inferior position. Your children won’t talk to you? Those selfish ingrates should thank you for raising them with discipline. When you believe you have lost because you are the better person, ressentiment protects your self-esteem but blinds you to your role in the problem.

Why feel resentful?

Resentment is painful and corrosive. Most resentment advice minimizes to two words: “Stop it.” What use could such a toxic feeling serve? It could enforce social norms by punishing those who act haughty and superior. It also could be protective. In the 1980s, political scientist Robert Axelrod wrote computer programs to test strategies for “Prisoner’s Dilemma” games, where success depends on smart choices on whether to cooperate with another. The most successful strategy was to cooperate with those who cooperated in earlier rounds and to thwart those who didn’t. Resentment reminds us who didn’t cooperate. When you pick at a scab, the wound will never heal, but you’ll never lose your reminder of how you were hurt.

Photo copyright 2012 by Emiliano SpadaHow can we work through it?

The Big Book Bunch  encourages those in recovery to write out a four-column summary of their resentments, and to examine the role they may have played in the problem. Taking responsibility can ease resentment, as long as that responsibility is present. A middle child who resents the youngest for taking up her parents’ attention can’t take responsibility for being born between siblings, for the younger child’s greater needs for parental attention, or for the parents’ limited supply of time and energy. Rational-Emotive Behavioral Therapy provides a less-invalidating approach: examine our beliefs about the situation, so we can shift our feelings from paralyzing resentment to healthier negative emotions, such as sorrow, disappointment or grief.

Discussion of healthier emotions (that is, those that lead us to more constructive, motivated thinking) raises the Thanksgiving Day question: If we’re trying to move back to healthier emotions, shouldn’t we try to shift to gratitude? Possibly not. As Ronnie de Sousa points out in a review of one of Solomon’s books, to be grateful to someone is to be in their debt. And to be in their debt is to place yourself in a position of subservience to them. And positions of subservience can lead straight back to … resentment.

 

@ 2012 Jonathan Miller All Rights Reserved

Leave a Comment

Filed under Uncategorized

Tagged as , ,

November 11, 2012 · 4:23 PM

What I learned from the Ethics refresher

Continuing education in counseling ethics is … Hey! Don’t nod off yet. Continuing ed in ethics is like tap water; flavorless and uninspiring, yet essential to our functioning. Caught short on ethics credits with license renewal slouching my way, I chose to go back to the basics.

An example of how exciting continuing education in counseling ethics is not.

I knew I would know most of the material. It meant passing up  advanced seminars with alluring promises of bullet-proof protection against lawsuits. But it’s too easy to get complacent about fundamentals. At risk of looking moronic to the more-recently educated, these seven points from Bruce J. Spencer’s “Applied Ethics” course caught my eye:

1. Bartering can be okay. 

Trading therapy sessions for goods or services has long been a no-no. There’s a high risk someone will wind up dissatisfied, and that will affect therapy. Spencer suggests it can be okay – in specific circumstances. If your client lacks health insurance or better options to pay, and the client likes the proposed deal, and a peer reviews it and agrees it seems fair,  and it’s written up in a formal contract,  then bartering might be appropriate. As unlikely as it seems, Spencer suggests that in impoverished areas with limited mental health services, bartering may be the most ethical choice.

2. How long to keep records? Maybe forever. 

State laws tell us to keep records between five to seven years. That may not be long enough. Per Spencer, there have been many cases where clients filed suit over years-old psychotherapy sessions.  With the documentation destroyed, the therapists had nothing in their defense except their word. Spencer suggests we save records of those dyspeptic clients who may grow disgruntled in future. Considering a career’s worth of electronic files can fit on a flashdrive the size of one’s thumb, one wonders if there’s a reason to dispose of any client’s records, ever.

3. Burn-out is a loss of faith.

If you can’t believe you can help others anymore, you’re probably right.

Most people view ideals and altruism as pleasant abstractions. Spencer sees them as essential to ethical practice.  To counsel clients, you have to believe (a) they can get better and that (b) you can help them do it,  (c) through therapy. When you’ve lost that confidence, you may play the role of a therapist, but you won’t perform effectively.

4.  Don’t put anyone else’s name in a chart.

You want to refer to people in your client’s life as, “The client’s second husband,” or “The client’s oldest daughter.” If the records ever get called into court and others are identified by name, those names will have to be redacted.

5. Not following up on homework could get you in hot water.

Spencer covers why we must set measurable goals to practice ethically. He also reveals therapists have been sued for not asking about progress on those goals – even for not asking clients whether they completed therapy homework.  Shocking? Not really. By relying solely on, “What do you want work on today?” the therapists floated aimlessly one session to the next. They failed to deliver services their clients agreed to and paid for. Since clients pay for our time and can’t be sure what they’ll need from one session to the next, it’s easy to regard treatment plans as busywork to satisfy insurance companies. Don’t.

6.  Void your safety contracts.

Are they this formal? It’s best to treat them as though they are.

Just because no-suicide agreements won’t hold up in court doesn’t mean “contract” is a metaphor. A contract is an agreement that ends when certain terms are fulfilled, or one of the parties breaks the contract.  Let’s say a client unexpectedly commits suicide months after signing a no-self-harm agreement. Concerned attorneys could point to the not-yet-voided contract as evidence the client was still in crisis and that we were negligent by not taking action. Spencer happily agrees this scenario is uncommon. Once a clients is out of crisis, we should document the safety contract is null and void, anyway.

7.  Clients can be scared to quit.

We all remember our first clients. They couldn’t have been scarier if they’d been nine feet tall with razor-sharp teeth.  It’s easy to forget licenses and degrees bring daunting professional authority, and that clients can feel scared of us. When we review our policies and the client’s rights in the first session, we need to cover their right to get a second opinion and to terminate therapy at any time. It’s hard for a client to get better if they don’t feel comfortable saying, “I think we’re done.”

@ 2012 Jonathan Miller All Rights Reserved

3 Comments

Filed under Uncategorized

Tagged as , , ,

October 16, 2012 · 10:22 PM

California bans conversion therapy for kids

California has passed a law stating psychotherapists may not defraud their clients. Advocacy groups have filed suit to defend their right to be defrauded. Quick-witted readers have deduced I’m writing about the Golden State’s new law banning conversion therapy for children under 18.

Aren’t broken – Can’t be fixed

 Conversion therapy promises to convert homosexuals into heterosexuals. It’s persisted for years despite a near-total lack of success; Freud himself rejected it as unlikely and unnecessary nearly 80 years ago. In the United Kingdom, the British Association for Counselling and Psychotherapy formally declared conversion therapy to be unethical this month. Their decision came in the wake of a scandal sparked by an exposé of conversion therapists who insisted the reporter must be depressed, compared homosexuality to cannibalism  and showed peculiar interest as to whether his family members were Freemasons.

The Pacific Justice Institute and Liberty Counsel have filed suit in Federal Court, demanding therapists be permitted to offer these services to kids. They pose the issue as a matter of free speech and religious liberty. Here’s why they’re wrong.

1. What about the success stories?

Which success stories? In his 2009 review of extant studies, B.A. Robinson found conversion therapy’s failure rate ranged from 99.5% to 100%. He notes that Joseph Nicolosi, founder of National Association for Research and Therapy of Homosexuality, an advocacy group for conversion therapy, had a strange definition of ‘success’. Per Robinson, Nicolosi stated that one-third of his conversion therapy clients became celibate but remained attracted to same-sex partners. Another third limited their sexual activity with same-sex partners, and one-third didn’t change at all.  Nicolosi considered the first two categories to constitute success. You could call that “celibacy therapy”, but not “conversion therapy”.

Religious groups’ success has been minimal to non-existent as well. Two of the founders of Exodus International left the organization in 1979. They lived and loved together in a committed relationship until death parted them twelve years later. The Rev. John Smid, who spent more than 22 years with another ex-gay ministry, Love in Action, admitted, “Actually I’ve never met a man who experienced a change from homosexual to heterosexual.” As the former Executive Director, you’d think he would have.

2. What’s the harm in trying?

Suicidal depression, for one.  The American Psychiatric Association condemned conversion therapy in 1998 and again in 2000 because of the  considerable anecdotal evidence of emotional harm.

Bamboozlement, for another If a patient asks his doctor to cure him of lupus, the correct response would be, “There is no cure. Let’s talk about managing your symptoms.” To take the client’s money without stating plainly that lupus is incurable would be fraud – even if one’s faith teaches lupus is against God’s will. Lupus, of course, is (a) a disease that (b) causes pain and suffering in and of itself, and (c) can be eased with medical treatment. None of those things are true of homosexuality. For therapists to promise to treat a condition that has no effect on mental stability is exponentially more deceitful.

Consider the suits state boards  filed against L.Ron Hubbard in the early 1950s. They successfully charged him with teaching medicine without a license through his Dianetics Foundation. Hubbard kept peddling Dianetics, but repositioned it as a religion called Scientology.  Discomfited by allegations the Scientologist ‘church’ exploits and abuses its members?  How you would feel if your insurance premiums helped pay for it?

3. Isn’t this political correctness run amok?

No. Religious groups have the right to their view that gay sex is wrong. When they ask courts to rule that homosexuality is a treatable mental illness, they’ve long since left their bailiwick.

 

@ 2012 Jonathan Miller All Rights Reserved

2 Comments

Filed under Uncategorized

Tagged as , , ,

September 29, 2012 · 5:18 PM

How far has therapy come since the 1970s?

Very far.

Note to clients: ethical therapists will not ask you to undress.

(thanks to V. Valenti)

 

@ 2012 Jonathan Miller All Rights Reserved

Leave a Comment

Filed under Uncategorized

Tagged as

July 14, 2012 · 10:29 AM

Stress Management Blogging #3

Leave a Comment

Filed under Stress Management Blogging, Uncategorized

June 24, 2012 · 8:49 PM

CBT by phone: Shorter-lasting effects for more.

There’s one kind of client no therapist can help – the one that doesn’t come in.  David C. Mohr, Ph.D, of the of the Northwestern University Feinberg School of Medicine, Chicago, IL,  has a new study that suggests they may not have to.

Alexander Graham Bell, inventor of the telephone.

In 2008, Mohr found clients will stick with therapy conducted over the phone longer than with therapy provided face-to-face. His latest study found that cognitive-behavioral therapy (CBT) for depression delivered over the phone was just as effective as the same therapy delivered face to face. Six months after treatment,  all the clients were still improved.

There was one catch:  the clients who met their therapists face-to-face were doing better at the follow-up than those who telephoned. 32% of those who came to their therapist’s office were depression-free compared to 19% of those who  phoned. Click the mp3 link on this page, and around the four-minute mark, you’ll hear Dr. Mohr describe the face-to-face clients as, “slightly better off.” This is an unnecessary understatement, considering the increased numbers who finished therapy.  Estimates of the drop-out rate in face-to-face therapy have ranged as high at 60%. Researchers have developed simplified feedback forms, helping some therapists reduce their attrition to around 18%. Mohr’s 2008 meta-analysis found the mean attrition rate for telephone psychotherapy was just 7.6%.

Sigmund Freud, father of modern psychology

Could coming to a therapist’s office for treatment increase the risk that a client will drop out?  Consider another industry whose consumers keep their customer status private: pornography. Reliable stats are rare, but it’s believed porn consumption exploded in the early 1980s, and did so again in the 2000s.  Changes in technology led the way. With the rise of the VCR, consumers could get their obscenity without visiting the seedy part of town. Once internet access spread, they didn’t even have to leave their home. There’s little reason to doubt most folks feel shame about going to a mental health center, just as they would about a grimy peepshow or massage parlor. Providing therapy by telephone would not only simplify clients’s busy lives, it would also remove low-level fears about being recognized at a therapist’s office.

Larry Flynt, pornographer. (Photo by David Livingston/Getty Images for COPE Health Solutions)

One can’t blame Mohr and Co. for trumpeting the effectiveness findings. Counseling someone you can’t see?  There have been long silences where I was grateful I could see my client quietly weeping or mulling things over. But  Mohr’s findings, and the number of successful blind therapists suggest visual contact’s importance may be overrated. Alexander Graham Bell invented the telephone in 1874. Sigmund Freud coined the term ‘psychoanalysis’ in 1894. In 2012, mental health therapy is still mostly conducted face-to-face in therapist’s office.  If combining Freud and Bell’s inventions would help more people, with only some decrease in the length of therapy’s effect, one is forced to ask, “Why not?”

 

@ 2012 Jonathan Miller All Rights Reserved

2 Comments

Filed under Uncategorized